179所三级医院ICU导尿管相关尿路感染防控护理实践的调查

doi:10.3761/j.issn.0254-1769.2022.22.010

摘要/Abstract

摘要：

目的调查26个省（区、市）三级医院ICU导尿管相关尿路感染（catheter-associated urinary tract infection，CAUTI）防控的护理实践现状，查找存在的薄弱环节，以便更好地指导临床护理实践。方法采用便利抽样法，利用自行设计的CAUTI防控护理实践现况调查问卷，于2021年9月22日—30日对26个省（区、市）179所三级医院ICU护士进行调查。问卷内容包括ICU基本情况、CAUTI防控的相关制度、流程与培训以及重点环节防控情况3个方面。结果共回收问卷436份，有效问卷368份，有效问卷回收率为84.40%。其中，330名（89.67%）被调查者所在科室常规进行CAUTI数据监测，仅有212名（57.61%）被调查者填写了上一年度CAUTI发生率，发生率中位数为0.86‰。置管环节，218个（59.24%）ICU有置管时的核查表，203个（55.16%）ICU常规使用硅胶导尿管，360个（97.83%）ICU有置管时的消毒操作规范，置管前使用的清洁消毒剂以含有效碘1 000~2 000 mg/L聚维酮碘溶液为主（89.95%）;导管维护环节，245个（66.58%）ICU有导尿管维护期间集束化措施核查表，237个（64.40%）ICU有每日审核留置导尿管必要性的提醒单/系统，258个（70.11%）ICU每周更换1次引流装置，168个（45.65%）ICU常规使用碘制剂进行尿道口清洁，57个（15.49%）ICU置管期间常规进行膀胱冲洗，292个（79.35%）ICU拔管前夹闭导尿管进行膀胱功能训练。不同ICU在最近3年本病区是否有关于CAUTI的持续改进措施和改进项目以及留取少量尿培养标本的方法3个方面比较，差异具有统计学意义（P<0.05）。结论目前各ICU在预防CAUTI的制度和流程上已较完善，但导尿管的留置和维护环节的防控措施有待进一步细化和规范，建议进一步加强CAUTI防控的相关培训与考核，切实降低CAUTI的发生率。

关键词: 重症监护病房, 导尿管相关尿路感染, 感染控制, 护理实践

Abstract:

Objective To explore the current status of nursing practice in the prevention and control of catheter-associated urinary tract infection（CAUTI） in ICUs of tertiary hospitals in 26 provinces（municipalities/autonomous regions），and find out the existing weaknesses to better guide clinical nursing practice. Methods Using the convenient sampling method and self-designed “Questionnaire on the Current Nursing Practice for the Prevention and Control of Catheter-associated Urinary Tract Infection”，the survey was conducted on nurses in 368 ICUs in 179 tertiary hospitals in 26 provinces（municipalities/autonomous regions） from September 22 to 30，2021. The questionnaire includes 3 parts，namely the basic situation of the ICU，relevant systems，processes and training and key aspects of CAUTI prevention and control. Results A total of 436 questionnaires were collected，with 368 valid questionnaires and an efficiency of 84.40%. Among them，330（89.67%） respondents reported that they routinely monitored CAUTI data in ICUs. However，only 212（57.61%） filled in the incidence of CAUTI in the previous year，with a median of 0.86‰. In the urinary catheter indwelling process，218（59.24%） ICUs had a catheter indwelling checklist;silicone catheter is routinely used in 203（55.16%） ICUs;360（97.83%） ICUs had disinfection specifications，and the cleaning and disinfectant before urinary catheter placement is mainly povidone-iodine solution containing 1 000~2 000 mg/L of available iodine（89.95%）. In the urinary catheter maintenance process，245 （66.58%） ICUs had a checklist of bundled measures;237（64.40%） ICUs had a reminder sheet/system for daily review of the necessity of indwelling urinary catheters;258（70.11%） ICUs routinely replaced the drainage device once a week;168（45.65%） ICUs cleaned the urethra with iodine preparations;57（15.49%） ICUs had bladder irrigation routinely;292（79.35%） ICUs clamped urinary catheter for bladder function training before extubation. There were statistically significant differences in continuous improvement measures，improvement projects in the last 3 years and methods for collecting a small amount of urine culture specimens for CAUTI in the ICUs（P<0.05）. Conclusion At present，the relevant systems and processes to prevent CAUTI in ICUs have been improved，but the prevention and control measures in the urinary catheter indwelling and maintenance processes need to be further refined and standardized. It is recommended to further strengthen the relevant training and assessment of CAUTI prevention and control to reduce the incidence of CAUTI effectively.

Key words: Intensive Care Units, Catheter-Associated Urinary Tract Infection, Infection Control, Nursing Practice

刘晨霞, 王霞, 邵欣, 刘聚源, 蔡虻. 179所三级医院ICU导尿管相关尿路感染防控护理实践的调查[J]. 中华护理杂志, 2022, 57(22): 2750-2757.

LIU Chenxia, WANG Xia, SHAO Xin, LIU Juyuan, CAI Meng. Investigation of nursing practice for the prevention and control of catheter-associated urinary tract infection in ICUs of 179 tertiary hospitals[J]. Chinese Journal of Nursing, 2022, 57(22): 2750-2757.

图/表 5

表1 参与调查的ICU所属地区（n=368）

Table 1 Regional distribution of ICUs（n=368）

表2 ICU预防导尿管相关尿路感染的制度、流程与培训的调查结果（n=368）

Table 2 The survey results of systems，processes and training for the prevention of catheter-associated urinary tract infections in the ICUs（n=368）

表3 置管环节导尿管相关尿路感染防控的护理实践现状（n=368）

Table 3 Current situation of nursing practice of catheter-associated urinary tract infections prevention and control in the urinary catheter indwelling process（n=368）

表4 维护环节导尿管相关尿路感染防控的护理实践现状（n=368）

Table 4 Current status of nursing practice in the prevention and control of catheter-associated urinary tract infections in the urinary catheter maintenance process（n=368）

表5 不同类型ICU导尿管相关尿路感染防控的护理实践情况比较

Table 5 Comparison of nursing practice status of prevention and control of catheter-associated urinary tract infection in different types of ICUs

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